Department of Surgical Oncology, UT-MD Anderson Cancer Center, 1400 Herman Pressler Drive, Unit 1484, Houston, TX, USA.
University Health Network, Toronto, ON, Canada.
Surg Endosc. 2019 Mar;33(3):679-683. doi: 10.1007/s00464-019-06661-w. Epub 2019 Jan 22.
Despite extensive first-hand surgical experience, rank and file members of surgical societies are generally not trained in and have not therefore been included in surgical quality measure development. The purpose of this exercise was to determine if a structured quality metric design tool could bridge this gap, facilitating rapid development of focused quality metrics by minimally invasive surgeon attendees of the April 2018 SAGES Annual Meeting.
Expert minimally invasive surgeons attended a 90-min workshop with didactic and interactive quality metric design sessions during the Annual Meeting. The interactive portion was formed around a novel structured quality measure development tool that graded presenting symptoms, short-term complications, and long-term disutility of care.
For first-time symptomatic inguinal hernia repair, first-time small to moderate size ventral hernia repair, and elective laparoscopic cholecystectomy, each workgroup was able to develop one quality, one short-term complication, and one long-term disutility metric.
A structured quality metric design tool facilitates application of knowledge through rapid development of multifaceted, patient-centric outcomes measures by expert minimally invasive surgeons, otherwise not formally trained in metric development. The exercise also highlighted the need to rigorously define denominator populations and to guard against metric-driven undertreatment.
尽管外科医生有丰富的第一手手术经验，但外科协会的普通成员通常没有接受过培训，因此也没有参与到外科质量衡量标准的制定中。本次研究的目的是确定一个结构化的质量衡量标准设计工具是否能够弥补这一差距，使微创外科医生能够在 2018 年 4 月 SAGES 年会上快速制定有针对性的质量衡量标准。
微创外科专家参加了一个 90 分钟的研讨会，会上有理论和互动质量衡量标准设计课程。互动部分围绕一种新颖的结构化质量衡量标准制定工具展开，该工具对主要症状、短期并发症和长期治疗不便进行了分级。
对于首次出现腹股沟疝修补症状、首次出现小至中度大小的腹侧疝修补和择期腹腔镜胆囊切除术，每个工作组都能够制定一个质量指标、一个短期并发症指标和一个长期治疗不便指标。
一个结构化的质量衡量标准设计工具可以通过专家微创外科医生快速制定多方面、以患者为中心的结果衡量标准，来应用知识，这些医生通常没有接受过衡量标准制定的正式培训。该研究还强调了需要严格定义分母人群，并防止因衡量标准而导致的治疗不足。
